title: Greater omentum folding in the open surgical placement of peritoneal dialysis catheters: a randomized controlled study and systemic review.
abstract: BACKGROUND
  Mechanical catheter dysfunction caused by omentum entrapment remains a major complication of peritoneal dialysis (PD) therapy. The purpose of this study was to determine the outcomes of omentum folding at the time of primary open catheter insertion.
  
  
  METHODS
  From March 2008 to December 2012, a total of 67 PD subjects were enrolled in the study and randomly assigned to receive either regular open insertion (ROI group, n = 33) or open insertion with omentum folding (OIOF group, n = 34). The primary outcome was defined as PD catheter tip migration with dysfunction. A systematic review was performed to analyze the outcomes of omentum management in PD catheter implantation, based on published data from 1990 to 2013.
  
  
  RESULTS
  There was no statistical difference in baseline patient characteristics between the ROI and OIOF groups. Nine (27.3%) patients in the ROI group presented with catheter malposition in the late stage (>60 days) of the study, significantly more than in the OIOF group (two; 5.9%) (P = 0.049). Significant differences in catheter survival rate between the two groups were observed in the late stage (P = 0.030) and over the entire study period (P = 0.028). A higher incidence of irreversible catheter dysfunction was shown in the ROI group (15.2%), whereas none occurred in the OIOF group (P = 0.031). No statistical difference was determined in other catheter-related complications or patient survival rate. There were no statistical differences in peritoneal transport characteristics or dialysis adequacy between the two groups upon evaluation at 3, 6 and 12 months. Systemic review of current publications suggested that PD catheter placement with omentum management could lead to less irreversible catheter dysfunction and improved outcome of catheter survival.
  
  
  CONCLUSIONS
  Our data suggest that omentum folding at the initial time of open catheter placement can significantly reduce the risk of catheter tip migration with dysfunction and improve the outcome of the PD technique.
authors.affiliation: Renal Division, The Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China.
authors.forename: Guochun
authors.initials: G
authors.lastname: Chen
authors.forename: Puzhang
authors.initials: P
authors.lastname: Wang
authors.forename: Hong
authors.initials: H
authors.lastname: Liu
authors.forename: Linshan
authors.initials: L
authors.lastname: Zhou
authors.forename: Meichu
authors.initials: M
authors.lastname: Cheng
authors.forename: Yinghong
authors.initials: Y
authors.lastname: Liu
authors.forename: Hongqing
authors.initials: H
authors.lastname: Zhang
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.forename: Lin
authors.initials: L
authors.lastname: Sun
authors.forename: Youming
authors.initials: Y
authors.lastname: Peng
authors.forename: Fuyou
authors.initials: F
authors.lastname: Liu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055499:Catheter-Related Infections / Q000401:mortality; D002404:Catheterization; D002408:Catheters, Indwelling; D018572:Disease-Free Survival; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy; D009852:Omentum / Q000473:pathology / Q000601:surgery; D010530:Peritoneal Dialysis
keywords: catheter placement; chronic kidney disease; omentum; peritoneal dialysis; randomized controlled trial